Deep Cervical Abscess Research Articles

Transoral traumatic perforation of the pyriform sinus by a marker pen: report of an infant case

BackgroundPerforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth.Case presentationAn 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111.ConclusionsAlthough injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.

Deep cervical abscesses in children: efficacy of the cefotaxime-rifampicin combination.

The objective is to determine whether a medical treatment, the combination of cefotaxime and rifampicin, is effective in avoiding surgery for managing deep cervical abscesses in children and to determine prognostic factors in the efficacy of this medical treatment. This is a retrospective analysis of all patients under 18 presenting with para- or retro-pharyngeal abscess over the period 2010-2020 in two hospitals' pediatric otorhinolaryngology departments. One hundred six records were included. Multivariate analyses were performed to study the relationship between the prescription of the Cefotaxime-rifampicin protocol at the onset of the management and the use of surgery and to evaluate the prognostic factors of its efficacy. The 53 patients who received the cefotaxime-rifampicin protocol as first-line treatment (vs. 53 patients receiving a different protocol) required surgery less frequently: 7.5% versus 32.1%, validated by a Kaplan-Meier survival curve and a Cox model analysis adjusted for age and abscess size (Hazard Ratio = 0.21). This good outcome of the cefotaxime-rifampicin protocol was not demonstrated when it was instituted as a second-line treatment after the failure of a different protocol. An abscess larger than 32mm at hospitalization was significantly associated with more frequent use of surgery in multivariate analysis adjusted for age and sex (Hazard Ratio = 8.5). Conclusions: The cefotaxime-rifampicin protocol appears to be an effective first-line treatment in managing non-complicated deep cervical abscesses in children. What is Known: • Nowadays, medical treatment is preferred for managing deep neck abscesses in children.There has yet to be a consensus on the antibiotic therapy to be proposed. • Staphylococcus aureus and streptococci are the most frequent causative organisms. What is New: • The cefotaxime-rifampicin protocol introduced at first intention is effective, with only 7.5% of patients requiring drainage surgery. • The only risk factor for failure of the medical treatment is the initial size of the abscess.

Characteristics and management of deep cervical abscess cases with upper airway stenosis

Characteristics and management of deep cervical abscess cases with upper airway stenosis

Deep Cervical Abscess Associated with Internal Carotid Pseudoaneurysm and Acute Ischemic Stroke: a case report

The formation of an internal carotid pseudoaneurysm is a rare complication of upper airway infections, mainly after the advent of antibiotic therapy. Despite the low incidence of this condition, it is an extremely serious and potentially lethal scenario; therefore, the rapid identification and establishment of an effective therapy is vital to patient. Normally, the proposed treatment is an immediate open ligature of the involved artery. Currently, new endovascular techniques have been used in the treatment of this pathology. Unfortunately, even after the establishment of adequate measures in order to contain hemorrhages, many cases evolve to cerebral ischemia, besides other complications. The present study reports the case of a four-year-old boy who presented with a right parapharyngeal abscess, which developed into an internal carotid pseudoaneurysm, treated with embolization. Regardless of the treatment, the patient had an unfavorable evolution, in which he had disease progression with fistula, hemorrhage and consequent acute ischemic stroke (AIS).

A Case of Deep Cervical Abscess After Upper Gastrointestinal Endoscopy

Patients with a deep cervical abscess sometimes show a serious course and require immediate surgical intervention. The main underlying causes if a deep cervical abscess are peritonsillar abscess, upper respiratory tract infection with acute tonsillitis, and dental infections; on the other hand, it can also, rarely, occur as a complication of medical procedures such as upper gastrointestinal endoscopic examination.

Ultrasound-guided Drainage vs Surgical Drainage of Deep Neck Space Abscesses: A Randomized Controlled Trial

IntroductionThe most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. MethodsA randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. Results128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The P-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DiscussionSurgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient’s airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. ConclusionsUltrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.

Deep neck abscesses-a diagnostic and therapeutic challenge

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deep neck space infections pose a diagnostic challenge, as they traverse complex anatomy, these patients develop devastating complications if the diagnosis is not made early.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a case series over a period of one year, reporting unusual presentation of deep neck abscesses. Patients were subjected to detailed history and clinical examination. Routine investigations, were done. After taking high risk consent, intra oral drainage of abscesses was done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the present study of 30 cases age group affected was 10 to 30 years with male predominance. Peritonsillar abscesses were seen in the adolescent age groups whereas retropharyngeal space infections were seen more in the adult population. Tuberculosis was the most common predisposing factor followed by diabetes. Dysphagia was the most common presenting symptom, followed by neck swelling. Intraoral drainage was done in 23 patients, intraoral drainage and ultrasound guided aspiration was done in 6 patients and 3 patient required emergency tracheostomy for securing of the airway.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Deep cervical abscesses still occur in the antibiotic era and may cause life-threatening complications.&lt;/p&gt;

Drenaje percutáneo ecoguiado vs. drenaje quirúrgico en abscesos cervicales profundos de origen odontógeno. Ensayo clínico controlado y aleatorizado

IntroductionThe most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. MethodsA randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. Results128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DiscussionSurgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. ConclusionsUltrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.

Deep cervical abscess following transesophageal echocardiography: A case report

Deep cervical abscess following transesophageal echocardiography: A case report

A rare case of cervical abscess caused by Parvimonas micra

Cervical abscesses develop in the tissue spaces between the cervical fascia. The rapid expansion of these abscesses can lead to fatal outcomes. We describe a case of a deep cervical abscess caused by Parvimonas micra. He was referred to our department with complaints of sore throat and neck pain. Ultrasonography revealed a hypoechoic area in the cervical interfascicular space. An ultrasound-guided puncture was performed to collect pus for bacteriological examination. Subsequently, a contrast-enhanced computed tomography scan revealed a multi-focal abscess extending from the left mandible to the left side of the neck, without any mediastinal abscess. An emergency drainage and antibacterial therapies were performed, and the patient progressed well. Parvimonas micra, a gram-positive anaerobic bacterium, was detected in the pus collected before incision, and appropriate antibiotics were immediately administered. The collection of pus prior to incision and drainage aids accurate identification of the causative organism and appropriate treatment.

A Study of Factors that Contribute to the Severe Progression of Peritonsillar Abscess

Abstract Background Based on the background factors and results of blood tests in patients with peritonsillar abscess, we investigated the factors involved in the prolongation of hospitalization and progression to deep neck abscess of these patients. Objective and Methods We studied the data of 113 patients with peritonsillar abscesses (including those in whom the condition progressed to deep neck abscesses) who were hospitalized at our department during the 3-year period from August 2014 to August 2017. Data of patients who needed hospitalized treatment for 7 days or more, including the age, body mass index (BMI), sickness period, white blood cell count, serum C-reactive protein (CRP), serum total protein, serum albumin, blood glucose, blood HbA1c, and estimated glomerular filtration rate (eGFR) at the first examination, and the neck factors in the cases that progressed to deep cervical abscess were examined using t-tests. Results The blood test items and background factors at the first visit were compared according to the length of hospitalization. The results revealed that prolonged hospitalization was associated with higher values of age, peripheral blood white blood cell count, serum CRP value and blood glucose, and lower values of serum total protein, serum albumin, and eGFR. Conclusions Factors that were associated with a longer hospital stay in this study were relatively high values of age, peripheral blood white blood cell count, blood glucose and serum CRP, and relatively low values of the serum total protein, serum albumin, and eGFR. The disease duration, BMI, and HbA1c were not identified as significant factors. Stepwise multiple regression analysis to identify factors associated with prolonged hospitalization identified the blood glucose and serum albumin levels measured at the first visit as significant predictors of a prolonged hospital stay and higher severity of the illness. Our findings suggested the importance of measuring these factors for predicting the progression to deep cervical abscess.

Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

BackgroundAnterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low.Case presentationHere, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame.ConclusionsThis case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Subphrenic abscess secondary to cervical abscess and fasciitis from dental focus: case report

BackgroundCervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer.Case presentationA 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae.ConclusionsAggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.

Abscesos profundos del cuello. Estudio retrospectivo de cinco años

I Introduction: Despite of incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. Material and method: Retrospective and descriptive study analyzed 11 patients between 2013-2017 in Puerto Real Hospital diagnosed with deep neck infections who had undergone surgical treatment and intravenous antibiotic with systematic review in the last 5 years. Results: There was a predominance in males (81.82%) and an average age of 52.82 years. Odynophagia was the most frequent symptom at the time of diagnosis followed by cervical pain. Tonsillitis in 55% and odontogenic infection (37%) were the most frequent etiologies. Polymicrobial was the most common bacteriology treated with clavulanic amoxicillin in 45.5%. Average of hospitalization days was 9.64 days. Diabetes and smoking were the most frequent comorbidities. Pleural effusion and mediastinitis were the most frequent complications, tracheotomy was required in 63.6%. 45.5% of patients were reoperated. In 54.5% multiple type of abscess was associated. Conclusions: The presence of multiple synchronous abscesses should be valued. Surgery and adequate antibiotic are the basis of the treatment. Immunocompromised or diabetic patients have more torpid evolution.

Enterococcus faecalisによる急性腎盂腎炎・敗血症に化膿性脊椎炎と深頸部膿瘍を合併した1例

Enterococcus faecalisによる急性腎盂腎炎・敗血症に化膿性脊椎炎と深頸部膿瘍を合併した1例

Odontogenic abscess with severe and fast evolution in a young and healthy patient

Deep cervical abscesses are infections of the different spaces on the the neck that may have a mild or severe outcome and requires fast and assertive approach. The most usual cases of severe infections are associates with comorbidities and older patients, but sometimes, in rare cases, it may affect the younger and healthier. Aim: The purpose of this is to communicate shortly a case of a severe cervical abscess with fast evolution in a 28 years old patient, to highlight the possibility of this outcome even in unexpected cases.

Phlegmonous esophagitis treated by endoscopic drainage

Phlegmonous esophagitis is a rare and sometimes fatal condition. Cases surgically treated have been reported previously; however, surgical approaches may be risky in the elderly. An 86-year-old woman presented with a sore throat and high fever after eating fish. She was first diagnosed with a deep cervical abscess, and conservative treatment was initially selected. However, her respiratory failure worsened, so emergent tracheostomy and surgical drainage were performed. Computed tomography showed intramural low-density lesions along the entire length of the esophagus and she was diagnosed with phlegmonous esophagitis. To avoid surgical intervention, endoscopic drainage was first attempted. Mucosal incision was made on the lower esophagus guided by endoscopic ultrasonography, using the insulated-tip electrosurgical knife. After the endoscopic drainage, her general health status improved, and the esophageal wall thickness was reduced. While some cases have recovered with conservative treatment, endoscopic drainage may be useful in certain patients.

Deep neck abscesses: study of 101 cases

IntroductionAlthough the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. ObjectiveThis study aimed to present our clinical-surgical experience with deep neck abscesses. MethodsA retrospective study analyzed 101 patients diagnosed with deep neck abscesses caused by multiple etiologies, assisted at a medical school hospital during 6 years. One hundred one patients were included and 27 (26.7%) were younger than 18 years old (the children group), 74 patients (73.3%) were older than 18 years old (the adults group). The following clinical features were analyzed and compared: age, gender, clinical symptoms, leukocyte count, the affected cervical area, lifestyle habits, antibiotic therapy, comorbidities, etiology, bacterial culture, time of hospitalization, the need of tracheostomy and complications. ResultsThere was predominance in the male gender (55.5%) and young people (mean age 28.1 years). All of the 51 patients with associated disease comorbidity were adults. The most frequent etiologies were bacterial tonsillitis (31.68%) and odontogenic infections (23.7%). The most common cervical areas affected were the peritonsillar (26.7%), submandibular/mouth floor (22.7%) and parapharyngeal spaces (18.8%). In children group, the site most commonly involved was the peritonsillar space (10 patients, 37%). In adults group, the site most commonly involved was multispace (31 patients, 41.8%). Streptococcus pyogenes (23.3%) was the most common microorganism present. Amoxicillin associated with clavulanate (82.1%) was the more used antibiotic. The main complications of abscesses were septic shock (16.8%), pneumonia (10.8%) and mediastinitis (1.98%). Tracheostomy was necessary in 16.8% of patients. The mortality rate was 1.98%. ConclusionThe clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.

Successful intubation using a specially bent lighted stylet to fit the upper airway passage of a patient with ankylosis of the temporomandibular joint and deep cervical abscesses -A case report-

Successful intubation using a specially bent lighted stylet to fit the upper airway passage of a patient with ankylosis of the temporomandibular joint and deep cervical abscesses -A case report-

A Case of Deep Cervical Abscess during Treatment of Subacute Thyroiditis

Subacute thyroiditis is a nonsuppurative inflammatory disease whose treatment differs from that of acute suppurative thyroiditis. We report herein on a case diagnosed as subacute thyroiditis in which a deep cervical abscess developed as a result of overdosing with a steroid hormone agent. The patient was a 55-year-old male whose chief complaint was anterior neck swelling. Based on sonography findings and blood sampling results, a diagnosis of subacute thyroiditis was made and a steroid hormone agent was administered. Though the symptoms were initially relieved, when the drug was withdrawn, they worsened again. The patient himself was an internist and based on his own judgment increased the dosage of the steroid hormone agent. On the 14th day following the initial examination, he was reexamined due to worsening of the neck swelling and respiratory discomfort. CT showed that a deep cervical abscess had developed and an emergency surgical intervention was conducted to drain it. Thus, despite a diagnosis of subacute thyroiditis, the possibility of acute suppurative thyroiditis should be kept in mind and appropriate action taken in view of the clinical course.